Provider Demographics
NPI:1720274509
Name:SOPHIA B PIERCE & ASSOCIATES INC
Entity Type:Organization
Organization Name:SOPHIA B PIERCE & ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:BLANKS
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:910-488-8477
Mailing Address - Street 1:PO BOX 2813
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28302
Mailing Address - Country:US
Mailing Address - Phone:910-488-8477
Mailing Address - Fax:910-822-1951
Practice Address - Street 1:1909 STANBERRY PLACE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301
Practice Address - Country:US
Practice Address - Phone:910-488-7436
Practice Address - Fax:910-822-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NCMHL-026-299311ZA0620X
NCMHL026299320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No251S00000XAgenciesCommunity/Behavioral Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH41590Medicaid